Incontinence and Obesity

It is estimated that approximately 78 million, or one-third of American adults are obese. We also know that about 30 million American adults suffer from urinary incontinence. The two may not seem related, but let's take a closer look. Could there be a link between the two?

Obesity, which is the accumulation of excessive body fat, can have negative effects on health. The body mass index (BMI) is a concept used to help determine obesy. BMI values over 30 define obesity, but >35 is severe obesity, with values >40 morbid obesity and >45 super obesity. Obesity is one of the leading causes of preventable death. It is associated with adverse effects on multiple body organ systems, including the urinary tract. It also affects the heart, endocrine organs, musculoskeletal and neurological systems as well as a patient’s mental health. Besides being a tremendous health problem, obesity-related medical treatments place a tremendous strain on health care costs resulting in between $147 and $210 billion a year, or nearly 10 percent of all annual medical spending.

Urinary incontinence the involuntary loss of urine is also a significant health problem in the US with costs being estimated at over $20 billion dollars yearly. It is estimated that over 25 million Americans suffer from urinary incontinence, and the rates dramatically increase over the age of 65. Incontinence also effects other organ systems especially the skin, is associated with urinary tract infections, and certain has a large impact on one’s mental health.

Weight loss surgery, or Bariatric Surgery, involves different surgical interventions that are recommended for patients with a BMI over 40. They involve various reconfigurations of the gastrointestinal tract that result in malabsorption or restriction that lead to weight loss.

Recently a study published in JAMA Internal Medicine from the University of California San Francisco has identified a decrease in incontinence rates after successful bariatric surgery. In patients who have lost between 26 and 29 percent of their body weight, significant improvement in the bladder control was noted. It was found that the more weight that was lost, the better the improvement was noted.

There are several reasons why such significant weight loss is associated with an improvement in urinary function. Incontinence comes in several different forms. Urge incontinence is described as having the sensation to void with the bladder contracting and leakage occurring prior to getting. Social incontinence refers to physical limitations that limit ones ability to get to a bathroom in time. Clearly with such significant weight loss, mobility will drastically improve enabling one to get to the bathroom in a more expeditious fashion.

In female patients who have experienced such significant weight change, the decrease in their body mass and will result in less mass effect on their pelvic organs, thus improving or decreasing the stress urinary incontinence (incontinence that occurs with an increase in the intra-abdominal pressure) that one experiences.

With massive weight loss, those suffering with diabetes will experience improvement in their disease status. Diabetes is associated with increased urinary volumes thus placing more of a stress on the genitourinary system. With improvements, less of a diuresis will occur, and incontinence will also improve.

Although incontinence is not routinely something that is focused on by the bariatric surgeons, this type of data may certainly lead to an increased awareness in the future. Additionally, after surgically correcting the biggest problem the morbidly obese are faced with, they may be better able to address other health concerns, and those with ongoing urinary incontinence, may at last be able to address the problem.

Jay Motola, MD, is a board-certified urologist and attending physician, Department of Urology, Mount Sinai West, and Assistant Professor of Urology, Icahn School of Medicine at Mount Sinai. Dr. Motola is a summa cum laude, Phi Beta Kappa graduate of Boston University, and earned his medical degree at the State University of New York at Stony Brook.